Integrated Care Manager

COMPANY OVERVIEW

Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the health care equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs and a dedicated care team. For more information on Zing Health, visit www.myzinghealth.com.

JOB DESCRIPTION:

The Integrated Care Manager will be responsible for conducting health risk assessments, coordination of care, and care management for MAPD, C-SNP, and D-SNP members.

ESSENTIAL FUNCTIONS:

Fundamental Components include but are not limited to: 

• Performs assessments of members, including Health Risk assessments per CMS regulation 
• Follows the patient through various transitions of care to ensure that any gaps in treatment plans are identified and remedied, and promote efficient health care delivery. 
• Participates in assessment activities to develop individualized care plans in coordination with the patient, family, and providers. 
• Applies case management standards of practice to focus on effective care of high-need members. 
• Serves as a member advocate and resource, and provides critical information and recommendations to the rest of the care team. 
• Maintains strong knowledge of Case management, community resources, and plan benefits to promote improved member experience and health outcomes. 
• Works collaboratively with the member (and caregivers), primary care physicians, specialists, and other care providers to ensure member compliance and adherence to the medical plan of care. 
• Assists the Health Services Team in implementing best practices for chronic care and disease management. 
• Follows standard protocols, processes, and policies. 
• Provides member education to assist with self-management and encourages members to make healthy lifestyle changes. 
• Interacts with Medical Directors, Pharmacists, Social Workers, Behavioral Health Clinicians, and Other Impact Team Members on cases 
• Makes referrals to outside sources. 
• Documents and tracks clinical reviews, member care plans, referrals, and findings. 
• Performs other duties, projects, and actions as assigned. 

QUALIFICATIONS AND REQUIREMENTS:

JOB REQUIREMENTS:

Required Skills:

• Registered Nurse (RN) with 3 years of direct clinical care to the consumer in a clinical setting. 
• Current, valid, unrestricted license  
• 3 years of managed care experience or other commensurate experience 
• Demonstrates strong clinical knowledge, ability to perform clinical assessments, ability to use critical thinking skills and has the capacity for continued learning. 
• Knowledge of plan benefit designs. 
• Demonstrated ability to perform case management & disease management activities. 
• Ability to demonstrate knowledge of and apply those to the job function and responsibilities. 
• Problem-solving skills: the ability to systematically analyze problems, draw relevant conclusions, and devise appropriate courses of action. 
• Verbal and written communication skills, including listening, discussing, and documenting medical needs with members, providers, internal staff/management, external vendors, and community resources. 
• PC proficiency to include Outlook, Word, Excel, database experience, and web-based applications. 
• Personal management skills — Plan and manage multiple assignments and tasks, set priorities, and adapt to changing conditions and work assignments. Teamwork — ability to work well with one or more groups. 
• Interpersonal effectiveness — Relate to co-workers and build relationships with others in the organization. 

Preferred Skills:

• CM or DM experience with a Managed Care Organization (MCO) 
• Patient education experience. 
• Bilingual – English and Spanish 
• Certification in Case Management or a nationally recognized health care certification. 

Member-centric Impact Statement:

The Health Services department ensures that members receive high-quality, evidence-based medical care and interventions. By closely monitoring clinical outcomes and implementing best practices, Clinical ME enhances member satisfaction, encourages retention through improved health outcomes, and supports productivity by reducing preventable complications and hospitalizations.

Zing Health offers the following benefits:

• A competitive salary based on the market
• Medical, Dental, and Vision
• Employer-Paid Life Insurance
• Paid Maternal Leave
• Paid Paternal Leave
• 401(K) match up to 4%
• Paid-Time-Off
• Employee Assistance Programs
• Several supplemental benefits are available, including, but not limited to, Spouse Insurance, Pet Insurance, Critical Illness coverage, ID Protection, etc.